Evaluating health reform with publicly available data: Establishing a methodological framework to assess over-the-counter hearing aids
Open Access DepositedThe complexity of health systems, coupled with the unpredictability of reform, presents significant challenges. As the worldwide population ages, policymakers have become increasingly focused on addressing common age-related chronic health conditions, such as hearing loss, through new reform. Untreated hearing loss is associated with adverse health and social consequences, and unfortunately, for many Americans, hearing aids have long been out of reach due to cost and accessibility. The recent introduction of over-the-counter (OTC) hearing aids aims to address these barriers. By leveraging publicly available health data, this research provides a methodological framework to identify and analyze the target population of this new reform. Using data from adults who took part in the 2021 National Health Interview Survey (NHIS), a retrospective cohort analysis was conducted to examine hearing aid utilization. NHIS core questionnaire responses were used to define three distinct groups: those who use hearing aids (Active), those who might benefit from them (Potential), and the general population (General). To assess and characterize these groups, a population health framework was established, with six domains and 43 determinants. Through binary logistic regression, the framework was found to successfully distinguish between groups (Active vs. Potential users and Active users vs. General population) and identify which determinants most influenced hearing aid adoption. Then classification and regression tree (CART) analysis demonstrated the ability to effectively predict hearing aid users while also confirming the key determinants as important predictive factors. These findings aligned with literature published before OTC hearing aids were made available, validating the NHIS as a reliable and representative data source. This approach provides a foundation to be repeated to examine the impact of OTC hearing aids in the post-implementation period. Similar approaches should be taken to evaluate other emerging health reforms.
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